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Extent of Elder Abuse Victimization

The full extent of elder abuse is uncertain. There are few reliable national measures of elder abuse. This is partially because there is no uniform reporting system for elder abuse in the U.S. Additionally, the available national incidence and prevalence data from administrative records are unreliable because states have different definitions of elder and different reporting mechanisms.

The Extent of Elder Abuse in Residential Care Facilities

Reports of Abuse in Assisted Living Facilities

In an NIJ-funded study of reports of abuse in assisted living facilities, verbal and psychological abuse were the most common forms of abuse reported by direct care workers. Overall, resident abuse by staff was relatively uncommon, but the study’s findings indicate that there is room for improvement, especially for verbal and psychological abuse.[2]

How the Research Was Done

Researchers sent questionnaires to administrators and direct care workers at a random sample of 1,500 assisted living facilities across the U.S. The questionnaires asked workers about observations and reports of abuse and exploitation of residents in seven categories: verbal, physical, psychological, caregiving, medication, material and sexual. The researchers received 1,376 questionnaires back from administrators (a response rate of 84 percent) and 12,555 questionnaires back from direct care workers (81 percent).

Factors associated with abuse. Some facility- and individual-level factors associated with abuse were low staffing levels, residents with dementia or physical limitations, and having an administrator with a shorter tenure and lower education level.

Resident-to-Resident Abuse in Nursing Homes

Researchers and caregivers are increasingly recognizing resident-to-resident elder mistreatment as a source of abuse in residential care facilities. In an NIJ-funded study, researchers found that staff reported higher rates of resident-on-resident abuse than was documented in reports and charts.[3],
[4]

The study sought to:

Enhance institutional recognition of resident-to-resident abuse.

Identify the most accurate method of reporting and detecting resident-to-resident mistreatment.

How the Research Was Done

The study was carried out in 10 nursing homes with 1,846 residents. The researchers gathered information about resident-to-resident abuse from residents and staff, observation by researchers, incident and accident reports, and chart reviews within a two-week period.

Findings:

Prevalence. The average number of incidents reported across the nursing homes ranged from 0 to 4.3, depending on the reporting mechanism — the direct service staff reported 4.3 incidents, but no incidents were documented in accident/incident reports.

Reporting accuracy. The direct service staff were the most accurate mechanism for reporting or detecting resident-to-resident elder mistreatment. The residents themselves were the second most accurate mechanism. The facilities’ accident/incident reports provided the smallest number of resident-to-resident mistreatment incidents.

Environmental factors. Environmental factors (i.e., loud noise or congestion in public spaces due to equipment, such as walkers) may contribute to resident-on-resident mistreatment.

Recommendations

Researchers concluded that the discrepancy between staff-reported rates of resident-to-resident mistreatment and rates recorded in reports and charts illustrated the need for better documentation practices. To improve reporting, documentation and management, the researchers suggest institutional support in the form of staff training and institutional guidelines setting out standard practices for how to address resident-to-resident mistreatment.